Evidence-based clinical use of insulin premixtures

Diabetology & Metabolic Syndrome

Carolina Piras de Oliveira¹  Mariana Narbot Ermetice³  Jorge Luiz Gross⁴  Márcia Nery²  Marcos Antônio Tambascia⁵ 

[1] Diabetes Group, Eli Lilly do Brazil São Paulo, São Paulo, Brazil;Diabetes Unit - Endocrinology and Metabolism Service, Clinical Hospital of Faculty of Medicine, University of São Paulo, São Paulo, Brazil;Currently at Novo Nordisk Brazil, São Paulo, Brazil;Department of Internal Medicine, Faculty of Medicine of Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil;Faculty of Medical Sciences, State University of Campinas, Brazil Rua Frei Manoel da Ressurreição 965, Campinas, SP, Brazil

关键词: Titration;    Treatment goals;    Glycated hemoglobin;    Lispro;    Premixed;    Insulin;    Type 2 diabetes mellitus;   

Others  :  812703
DOI  :  10.1186/1758-5996-5-50

 received in 2012-11-13, accepted in 2013-05-17,  发布年份 2013

【 摘 要 】

Brazil is expected to have 19.6 million patients with diabetes by the year 2030. A key concept in the treatment of type 2 diabetes mellitus (T2DM) is establishing individualized glycemic goals based on each patient’s clinical characteristics, which impact the choice of antihyperglycemic therapy. Targets for glycemic control, including fasting blood glucose, postprandial blood glucose, and glycated hemoglobin (A1C), are often not reached solely with antihyperglycemic therapy, and insulin therapy is often required. Basal insulin is considered an initial strategy; however, premixed insulins are convenient and are equally or more effective, especially for patients who require both basal and prandial control but desire a more simplified strategy involving fewer daily injections than a basal-bolus regimen. Most physicians are reluctant to transition patients to insulin treatment due to inappropriate assumptions and insufficient information. We conducted a nonsystematic review in PubMed and identified the most relevant and recently published articles that compared the use of premixed insulin versus basal insulin analogues used alone or in combination with rapid-acting insulin analogues before meals in patients with T2DM. These studies suggest that premixed insulin analogues are equally or more effective in reducing A1C compared to basal insulin analogues alone in spite of the small increase in the risk of nonsevere hypoglycemic events and nonclinically significant weight gain. Premixed insulin analogues can be used in insulin-naïve patients, in patients already on basal insulin therapy, and those using basal-bolus therapy who are noncompliant with blood glucose self-monitoring and titration of multiple insulin doses. We additionally provide practical aspects related to titration for the specific premixed insulin analogue formulations commercially available in Brazil.

【 授权许可】

   
2013 Tambascia et al.; licensee BioMed Central Ltd.

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